Pushing On With Play

Typically developing children tend to be very clear about their preferred types of play. Verbally requesting games or preferred play things is common as little ones grow up- you only need to look at the Santa Claus list of an average 6-10 year old to confirm this! However, even before they develop the words to tell us what their current favourite toy is, parents tend to know what it as that their children like to play with. Babies and toddlers may point at or reach for an object that is of high interest to them, may cry when they are separated from a play thing that they are particularly attached to, and may show obvious signs of happiness and engagement when observing or participating in a particular type of play. Think, for example, of how many babies will laugh watching an adult playing peekaboo.

When we consider children with higher support needs, preference becomes more of a grey area. For children with a profound physical or learning disability, expressing their likes and dislikes in the arena of play can be a big challenge. For many children that fit this description, play tends to be more of a passive experience- parents may select the toys and materials that they interact with, and the interaction itself may be grounded in observation rather than active participation. In my work as an occupational therapist, I always ask parents about a child’s preferred type of play in my initial interviews, and in the case of high support clients the answers I get usually sound something like this- ‘oh, well have insert popular toy name here, and we do play with it, but I don’t know how much he/she really likes it’. Families become frustrated at not seeing the signs of engagement in play that they might have noticed in older siblings, and may end up abandoning their attempts to play with a high support child altogether out of well-placed concern that the child is not enjoying the experience. Indeed, many families come to believe that the precious one to one time they have with their high support child is better used developing practical skills, such as feeding or dressing, rather than playing- after all, their child just doesn’t seem to get anything from the play opportunities offered to them, so why push on?

I would like to suggest that when it comes to children with high support needs, we re-examine how we measure engagement in play, and the benefits that may arise from different types of engagement. Below I have listed five questions to ask yourself about alternative ways that your child with high support needs might engage with play-based tasks.

Are they gaining sensory stimulation from the play?

If you have worked with an OT previously and they have assessed your child’s sensory profile, then this will be of great use when considering this question. If not, have a think about what you have observed in terms of your child’s sensory preferences and go from there. Does your child turn their head to see where the noise is coming from when you play the radio in the car? If so, maybe a music-based cause and effect toy would help them to meet their craving for auditory stimulation. Does your child lean into you when you’re wearing a particular perfume? If so, maybe adding drops of essential oils to a tub of warm water and letting them watch as you gather and pour from a mug would be a nice piece of olfactory stimulation. Think of all the different senses and how you can incorporate them into your play.

Is the play having a calming effect?

Observing play, particularly repetitive, predictable play, can put a person into a ‘flow state’. It can be very calming, for example, to watch somebody else sort and stack coloured blocks. In my practice, I have found this particularly true of high support clients with an additional ASD diagnosis- sorting tasks make visual sense. So how do we judge if a high support child is in a state of calm? When I want to gauge how calm a person with high support needs is, I find it easiest to think of what that person looks like when they are extremely stressed. Do they grind their teeth? Do they become increasingly vocal? Do they hit out? Do they cover their eyes or ears in an attempt to block out their surroundings? Then I work backwards. So for example, if a person who is very vocal when stressed is suddenly dead silent when watching a play task, it implies a sense of calm. When a person who covers their eyes when stressed is suddenly maintaining eye gaze on a task, it implies a sense of calm. What does your child’s ‘stress signature’ look like, and is it evident when you engage them in play?

Are they sustaining concentration during the play?

Does your child watch you as you engage in play? If so, how long do they hold eye gaze for? An interesting experiment might be to time how long your child holds eye gaze while you play- generally, the longer they do so, the more interested they are. This can give great insight into what sort of play they are most intrigued by- do they enjoy watching you engage in imaginative play, such as with dolls, or are they more impressed by building Lego? Even if you have found a play activity that your child seems to be interested in, I would encourage continuing to monitor eye gaze- for some children, the novelty of activities can wear off quickly, and trialling different types of play on a regular basis may be more stimulating for them. For others, the same activity will be preferred for long periods of time. What are some other signs that your child is paying attention to something?

Is the play giving them a chance to develop the basics that underpin practical skills?

When we get caught up in teaching ‘life skills’, we often forget that it is the basic skills that we picked up from play that allow us to perfect them. For example, we can become fixated on improving fine motor skills to enable the child to take a spoon of their dinner independently, and in doing so we can forget that submerging your hand in a sensory bin of beads can help to refine our dexterity. Playing and skill development therefore are not, by any means, mutually exclusive- in fact, I would argue the polar opposite. As an exercise to reframe how you see the benefits of playing, take any play activity and break it down into its core components- think of what it demands on a sensory, physical, and interactive level. You will certainly be surprised at just how much there is to a simple task, and even if your child only engages in observation, then they are watching you model all of these skills. I would like to put a disclaimer at the end of this point, however- please do not let play become skills training. It is very important that skill acquisition remains just a happy side effect of a fun activity. Which brings me nicely on to my final question-

Is the play an opportunity for them to interact with you purely for pleasure, without demands?

Lastly, and in my opinion most importantly, comes the psychosocial benefits of play. Think about a day in your life- it is likely that you have a number of natural opportunities to interact with others purely for pleasure. Whether it’s the small talk with a colleague while pouring a coffee between meetings, or messaging a friend with a silly internet meme that made you think of them, or laughing with a spouse over a favourite TV programme; these are the little building blocks that stack up to sate our innate need to be included and wanted. Now imagine the life of somebody with high support needs. There are so little things that they can do independently, and this means that even opportunities that would represent a chance to simply be social for others suddenly become another time where communication becomes purely functional and demand-based. Meal times, for example, can become less about sharing the news of the day, and more about following instructions- ‘now lift the spoon to your mouth’. Taking time out to simply have fun around your high support child may be one of the only times in their day that someone communicates with them simply because they’re a person that somebody else enjoys being around- and this forms a very important piece of all of our senses of self-worth.

So in conclusion- keep on asking, keep on challenging, but most of all keep on playing! You are doing so much more for your child than you know. If you have any other tips for parents of high support children, please feel free to leave suggestions in the comments.